Rabies: The Devil Takes The Hindmost

20. July 2015

In many regions of Africa and India quadrupeds are vectors of the rabies virus. Knowing this it would then not be hard to eradicate rabies in these areas – and without high costs. Western countries should not stand aloof on the matter. One sticking point: poverty-associated diseases are hardly being studied.

In Europe and North America rabies has long been a marginal phenomenon, with the exception of that associated to bats. At the same time doctors in India and sub-Saharan Africa have reported a number of cases caused by dog bites. There has been a lack of exact figures on this, since many countries do not collect data themselves. They quite simply lack the appropriate infrastructures. Researchers have now attempted to quantify the extent of this.

High costs for the economy

Katie Hampson, Glasgow, as part of her study evaluated various sources. Teams surveyed doctors, veterinarians and laboratory physicians in their respective areas. In doing this Hampson obtained at minimum a rough estimate, albeit with extreme scattering. Year in year out, according to extrapolations, 25,000-159,200 people die from rabies. Felix Lankester, Pullman, in one paper makes mention of “more than 69,000 victims” [Paywall]. Most deaths occur in Asia (59.6 per cent) and Africa (36.4 percent). What’s surprising: In Latin America, Haiti is considered a “hot spot” – with approximately 70 percent of all infections based in the region. The consequences are disastrous: In sum total rabies leads to an economic loss of 3.7 million human life years and to losses of 8.6 billion US dollars per year. Given this huge impact, the costs of consistently vaccinating dogs would end up being negligible, adds Katie Hampson. Post-exposure prophylaxis soaks up significantly more money, if one puts aside the lack of availability of suitable vaccines as an issue. In the absence of prior post-exposure vaccination, with only few exceptions infection leads within 15 to 90 days to death.

Vaccines for the world

Lankester strikes a similar note: most of the time patients get infected with the deadly virus through dogs. In pure statistical terms domestic dogs exist as the greatest risk, especially at the high population densities which occur in certain African countries. They transmit the virus to as many as two other living beings, including humans, until they perish themselves. It’s right here that health authorities and NGOs ought to find a starting point, says a key requirement being pushed. Next place in the list is occupied by stray species, followed by wild animals. Several countries have initiated mass vaccination of domestic dogs. In South Africa, Tanzania, Zimbabwe, and Chad less than eleven percent of all animals are ownerless. Against this backdrop, vaccination rates of 70 percent are able to be carried through – at 100 US dollars per square kilometre. The probability of a rabies outbreak under these conditions is close to zero. The fact that physicians, veterinarians and authorities can work together to eradicate rabies is something made particularly evident in some areas of Latin America. Here it has been possible to reduce cases of disease in dogs by 99 percent. Sustainable concepts however are met by some local politicians with scepticism. As is too often the case they react to problems instead of acting. The best example: in 2008 due to inadequate quarantine regulations a rabid dog made it into Bali. It infected other animals and an avalanche effect was the outcome. As a result, there were an estimated 130 deaths. In April 2015, authorities roused themselves into vaccinating dogs consistently. Whether rabies can be controlled by vaccine alone is another question.

Left out in the cold instead of in with the group

In this context, voices which criticise pharmaceutical manufacturers are loud. Rare diseases are placed quite some way down the priority list. With rabies the vaccines regularly become scarce; this was most recently the case in February. Rapid tests are absent, as well as is pharmacotherapy. Doctors are currently not able to detect or rule out presence of viral infections immediately after exposure occurs. Where lack of interest in neglected diseases can lead us is something which had to be experienced first-hand by the international community with Ebola. MSF Germany criticised the sometimes excessive prices for vaccines. Vulnerabilities are meanwhile admonished. “Ebola is the worlds’s failure in global health research all laid open dramatically for all to see”, explains Philipp Frisch from MSF. “What’s more, when dealing with other illnesses our teams are often helpless because effective, appropriate and affordable drugs, vaccines and diagnostic tools are lacking”. Therefore, experts from several countries suggest internationally-oriented innovation and research funds, funded through the budget of all G7 countries. Their idea: government-supported product development partnerships between research institutions, foundations and manufacturers. It’s now up to national leaders and heads of government to show their colours.